Is "tree in bud " nodularity serious?

Posted by leilam @leilam, Jun 9, 2023

I was diagnosed with bronchiectasis many years ago but recently had sputum positive for Mac. Because of my age (86) my ID decided to just watch and not treat.
I had a CT scan last week and it came
back with a reading of " tree in bud" nodularity throughout the basilar segments right lower lobe. Everything else was normal except for calcified granuloma left long base which is not new. I just wondered if this is something I should be concerned about. I don't see my Pulmonologist until September.

Interested in more discussions like this? Go to the MAC & Bronchiectasis Support Group.

Sue, we are lucky to have you as our advocate….you are the best communicator! And have a caring delivery of information. Thank you for all you do.
Regina

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@cmi

Sue, we are lucky to have you as our advocate….you are the best communicator! And have a caring delivery of information. Thank you for all you do.
Regina

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Ditto! Thanks so very much, Sue!

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@sweethighland

Sue, my latest CT stated that "ground glass opacities", but mild improvement. Would GGO goes away on its own? Radiologist stated that chronic infections. I have yet to hear from my pulmo.

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I knew I had seen this explanation before, but I just had time to look for it this morning:
"Ground glass opacity (GGO) refers to the hazy gray areas that can show up in CT scans or X-rays of the lungs. These areas show increased density inside the lungs that could indicate pneumonia and other respiratory disorders.
The term comes from a technique in glassmaking during which the surface of the glass is blasted by sand. This technique gives the glass a hazy white or frosted appearance." From:
https://www.medicalnewstoday.com/articles/ground-glass-opacity
So, in essence, the CT findings are saying to the doctor "Consider this along with your patient's health history and other symptoms."
By the way, if you do Google for a term, and "Med News Today" comes up as a source, their explanations are usually very clear, balanced and understandable. MUCH better than any Facebook page or blog, and much easier to read than a research paper from NIH.

I like to find these explanations in layman's terms so I done' need a medical encyclopedia to figure out what the report is saying!
Sue

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@sueinmn

Yes, "ground glass opacities" are often seen during and after bouts of pneumonia and other lung illnesses. Sometimes they disappear as the infection subsides, other times it takes a while. Or if the infection or illness becomes chronic the GGO may stay.
When I had MAC and Pseudomonas at the same time, my lungs were full of GGO plus nodules, possible cavities... ow 5 years later, I still have Bronchiectasis, a few small nodules and some scar tissue. No GGO on the last CT 9 months ago.
So all of these signs can come and go.
Sue

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Sue,
This is a personal question. Did you take the big 3. I have Bronchiectasis, MAI, and Kansaii. The Mai did not show up in the last sputum extended 4 week growth test. I will not take the big 3. I have wet macular degeneration in one eye and my hearing loss requires me to wear hearing aides.
Thank you for your continued support and compassionate uplifting responses. You have taken me off the cliff. Several times.❤️

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@sallyb827

Sue,
This is a personal question. Did you take the big 3. I have Bronchiectasis, MAI, and Kansaii. The Mai did not show up in the last sputum extended 4 week growth test. I will not take the big 3. I have wet macular degeneration in one eye and my hearing loss requires me to wear hearing aides.
Thank you for your continued support and compassionate uplifting responses. You have taken me off the cliff. Several times.❤️

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Yes, I did for 18 months due to the severity of my infection. After learning on Mayo Connect about airway clearance, and eventually 7% saline, I asked to stop due to feeling worn out from treatment, even though I still had positive cultures. That was 3 1/2 years ago, and with continued prevention practices, I am still okay. Won't know how my lungs look until my next CT in December.

I'm pretty sure, as sick as I was, that the drugs were vital for me. But every case is different, and if mine was mild, I would plead my case for "watch & wait" with daily airway clearance, periodic sputum testing and CTs.
Sue

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@sueinmn

and @leilam Just wanted to repeat, for everyone, that not every radiologist is an expert in lung diseases and/or conditions. And most do not have access to your complete medical record.
The language the radiologist uses to report to the ordering physician is their medical "dialect" for lack of a better term. The radiologist says "tree in bud", "ground glass opacities", "fibrotic changes", etc and what areas are infected. If they are experienced, and certain features jump out at them, they may add "characteristic of NTM" or "indicative of bronchiectasis".
The pulmonologist takes both the CT images and the description, along with their knowledge of your condition, and figures out a diagnosis. If the conclusion is still uncertain, they may consult with other professionals or order additional tests.

That is why it is important to take a step back and have a conversation with your doc after seeing the reports on your patient portal. Jumping to "Dr Google" can lead to extra anxiety. Maybe just a phone call can tell you if the doc feels it is necessary to move forward sooner.
Sue

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Hi Sue. I couldn’t find where to post this question so thought you would know.
If I have MAC in one lung can or will it spread to the other one?
Thanks

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@rchildress

Hi Sue. I couldn’t find where to post this question so thought you would know.
If I have MAC in one lung can or will it spread to the other one?
Thanks

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Hi Renee - That's a good question! And I don't know the answer, either. Are you up for a challenge? Would you do a little research on line and see if you can find out? I bet there are a lot of people like me who would love to know the answer.
Sue

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@sueinmn

Hi Renee - That's a good question! And I don't know the answer, either. Are you up for a challenge? Would you do a little research on line and see if you can find out? I bet there are a lot of people like me who would love to know the answer.
Sue

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I am a good researcher so I’ll get at that. I just was hoping someone already knew the answer. Lol
I will report when I find out the answer.

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@sueinmn

Hi Renee - That's a good question! And I don't know the answer, either. Are you up for a challenge? Would you do a little research on line and see if you can find out? I bet there are a lot of people like me who would love to know the answer.
Sue

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Perhaps this is relevant here. Since my CT scan didn't show a lot of change after five years, I was wanting to watch and wait when bronchoscopy turned up MAC last November. I requested a second opinion and was lucky enough to get to see Dr. Kevin Winthrop, ID at OHSU, and he has convinced me to treat now, by showing me that although there is not a lot of change on my scans, there are now signs of disease in my left lung as well as the right, and that it is likely to continue to spread. My sputum test is again positive for MAC, now waiting for susceptibility findings, and I will see him this week to determine treatment, possibly as a participant in one of his clinical trials.
Anna

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